Outcomes for Whites and Blacks at Hospitals That Disproportionately Care for Black Medicare Beneficiaries
| Autor: | M.P.H. Lenny López M.D., M.P.H. Ashish K. Jha M.D. |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2012 |
| Předmět: |
medicine.medical_specialty
Quality management media_common.quotation_subject Ethnic group Psychological intervention Myocardial Infarction Medicare White People Health administration Hospital Administration Outcome Assessment Health Care medicine Disparities in Care Humans Healthcare Disparities media_common Heart Failure business.industry Health Policy Mortality rate Pneumonia Payment United States Black or African American Family medicine business Medicaid Cultural competence |
| Popis: | Racial and ethnic disparities in care are well known, although the reasons underlying them are still not well understood (Smedley, Stith, and Nelson 2002). Prior studies have found that care for minorities is highly concentrated, with a large proportion of minority patients receiving care from a small number of providers who generally provide a somewhat lower quality of care, at least as measured by process indicators (Bach et al. 2004; Baicker et al. 2004; Hasnain-Wynia et al. 2007; Jha et al. 2007a, b; Jha et al. 2008). In addition, prior research has focused on mortality for a single disease process using older Medicare data. Whether these hospitals have worse outcomes across multiple medical conditions, at least as measured by mortality rates, is not fully known. Finally, the heterogeneity in hospital characteristics of hospitals that care for a disproportionate number of blacks has not been fully explored. Understanding outcomes at hospitals that disproportionately care for minorities is important, especially in light of the national Value-Based Purchasing (VBP) effort by the Centers for Medicare and Medicaid Services, which will now use mortality rates as part of its payment scheme. If hospitals that disproportionately care for minority patients have worse outcomes, they are likely to be penalized under the scheme. Furthermore, if they do have worse outcomes, understanding why their outcomes are worse is critically important for any quality improvement effort. For instance, if the hospitals that disproportionately care for minority patients provide worse care for all their patients, then targeting quality improvement efforts at these providers will likely have an important effect. Alternatively, if these hospitals provide largely similar care and any gaps between whites and minorities represent “within” hospital differences, then the interventions needed will be very different and likely require efforts such as cultural competency training for staff. Yet we are unaware of any data that examine how mortality rates vary between minority-serving and nonminority-serving institutions and what explains any gaps in mortality that might exist between these two types of hospitals. Empirical data here are critically important for understanding how these hospital might fare under VBP and what we might do to improve care at these institutions. Therefore, in this study, we sought to answer three questions: First, do hospitals with a high proportion of black patients generally have worse outcomes than hospitals with fewer black patients? Second, can these gaps, if any, be explained by differences in key structural characteristics between black-serving and nonblack-serving hospitals? And finally, if black-serving hospitals (BSHs) do have worse outcomes, do these differences in outcomes extend to white patients, black patients, or both? |
| Databáze: | OpenAIRE |
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